VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Grandview Adult Care, LLC
27294 Denton Valley Road
Abingdon, VA 24211

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: July 25, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 07/25/2023, 7:25am to 12:18pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 16 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-380-A
Description:	Based on a review of resident records, the facility failed to obtain all required personal and social information prior to or at the time of admission for one resident. EVIDENCE: 1. The Personal/Social Data form for resident #2 did not contain information regarding resident current behavioral and social functioning, including strengths and problems.
Plan of Correction:	Resident #2 Personal Social Data Sheet was modified with the additional information. [SIC]
Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records, the facility failed to address all identified needs on the comprehensive Individualized Service Plan (ISP) for one of the six resident files that were reviewed. EVIDENCE: 1. The UAI in the record for resident #1, dated 08/02/2022, identifies judgement problems and abusive/aggressive/disruptive behavior ? weekly or more. The comprehensive ISP in the record for resident #1, dated 06/02/2023, does not address these needs.
Plan of Correction:	The ISP of resident #1 has been modified with additional assessed needs. ISP revised to include assessed needs from their UAI. [SIC]
Standard #:	22VAC40-73-640-A
Description:	Based on observations made during the medication cart audit, the facility failed to adhere to their medication plan regarding methods to prevent the use of outdated and damaged medications. EVIDENCE 1. Resident #7 is prescribed Med-Pads 50% hemorrhoid pads, apply four times daily rectally as needed. This medication was found in the medication cart, but did not have an open date on it. 2. Resident #8 is prescribed Ammonium Lactate 125 Lotion, apply to feet and hands as needed daily. This medication was found in the medication cart, but did not have an open date on it. 3. Resident #9 is prescribed Mupirocin 2% ointment, apply to affected right ear as needed. This medication was found in the medication cart, but did not have an open date.
Plan of Correction:	Resident #7 the physician was contacted about the non-use of hemorrhoid pads and discontinued the order. Resident #8 new medication was ordered and dates were modified. Resident #9 new medication was ordered and dates were modified. All old medications were discarded. [SIC]
Standard #:	22VAC40-73-680-D
Description:	Based on resident record review, the facility failed to administer medication in accordance with the physician?s or other prescriber?s instructions. EVIDENCE: 1. Resident #9 has a physician?s order dated 06/06/2023 to check blood pressure twice daily and to hold metoprolol tartrate for systolic blood pressure less than 110, diastolic blood pressure less than 60 or pulse less than 60. 2. According to the ?Blood Pressure Check? form used by the facility to record blood pressure readings and pulse rates, and the July 2023 MAR, the facility administered metoprolol tartrate on the following days when the pulse rate was less than 60 at 8:00am: 7/1, pulse 45; 7/2, pulse 44; 7/4, pulse 58; 7/5, pulse 52; 7/6, pulse 50; 7/7, pulse 50; 7/9, pulse 58; 7/14, pulse 51; 7/21, pulse 45; 7/25, pulse 54. 3. According to the ?Blood Pressure Check? form used by the facility to record blood pressure readings and pulse rates, and the July 2023 MAR, the facility administered metoprolol tartrate on the following days when the pulse rate was less than 60 at 8:00pm: 7/1, pulse 50; 7/2, pulse 44; 7/3, pulse 52; 7/4, pulse 59; 7/5, pulse 59; 7/6, pulse 56; 7/8, pulse 54; 7/9, pulse 59; 7/10, pulse 58; 7/17, pulse 48; 7/20, pulse 55; 7/24, pulse 47. 4. According to the ?Blood Pressure Check? form used by the facility to record blood pressure readings and pulse rates, and the July 2023 MAR, the facility did not administer metoprolol tartrate at 8:00am on 7/24/2023 (blood pressure: 117/65, pulse: 65) and at 8:00pm on 07/24/2023 (blood pressure: 131/64, pulse: 62).
Plan of Correction:	1. Implement order review and verification weekly. 2. To document prescribed orders on individual blood pressure checks forms ensuring order is checked with each result obtained to avoid administering against orders. 3. Making notations on MAR to ensure prescribed orders for vital signs will not be overlooked and documentation in multiple sites will also ensure correct procedures. 4. Schedule training to educate med aides on importance of verifying orders, checking MAR and review resident records daily. (The blood pressure for July 24 was mistaken for the B/P on the 23rd both PM. The B/P for the 24th PM was 107/53 heart rate 47 and he didn?t receive the B/P pill that day. The B/P for the 24th in the AM was signed and circled by accident but did receive the medication.) [SIC]
Standard #:	22VAC40-73-750-B
Description:	Based on observations made during the tour of the building, the facility failed to have a sturdy chair for each resident in one resident room. EVIDENCE: 1. Room #13 has two residents residing in the room. There was only one chair available in room #13.
Plan of Correction:	Room #13, the chair was replaced and put in the room. [SIC]
Standard #:	22VAC40-73-860-D
Description:	Based on observations made during the tour of the building, the facility failed to have an operable window effectively screened. EVIDENCE: 1. Resident room #12 had a window that was not screened. According to staff #4, the window is operable.
Plan of Correction:	Room #12 was looked at and a screen was placed in the window. [SIC]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during the tour of the building, the facility failed to keep all furnishings, fixtures, and equipment clean and in good repair and condition. EVIDENCE: 1. The folding door covering the entrance to the furnace was off the track at the top of the door and was found to contain dust particles on the bottom portion of the door. 2. One of the four white chairs was found to have a tear approximately eight inches long and two inches deep in the seat portion of the chair. 3. The blue bathroom was found to have a tear approximately 10-12 inches long in the linoleum flooring in front of the toilet.
Plan of Correction:	1. The door entrance to the furnace was fixed with a new curtain. Repaired and cleaned. 2. The white chair on the porch was repaired. 3. The floor in the blue bathroom was repaired. [SIC]
Standard #:	22VAC40-73-920-D
Description:	Based on observations made during the tour of the building, the facility failed to have sturdy safeguards in compliance with the Virginia Statewide Building Code for one bathroom. EVIDENCE: 1. The downstairs bathroom did not have handrails by the bathtub, inside the shower, and did not have grab bars by the toilet.
Plan of Correction:	The downstairs bathroom was fixed with a handrail by the toilet and the bathtub. [SIC]